Oligometastatic Breast Cancer: How to Manage It?
Abstract
:1. Introduction
2. Options for Treatment of Oligometastatic Breast Cancer
2.1. Surgery
2.2. Radiotherapy
2.3. Systemic Treatments
2.4. Combination of Radiotherapy and Systemic Treatment
3. Conclusions
4. Future Directions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Trial | Number of Patients | Site of Metastases | Biological Subtype | Site of Surgery | Outcome |
---|---|---|---|---|---|
Tata Memorial, NCT00193778 | 350 | Bone and/or visceral | HR+ /HER2− HR+/HER2+ |
| 1. No differences in OS 2. Better locoregional PFS FOR surgery 3. Worse DPFS for surgery |
MF0701, NCT00557986 | 274 | Bone and/or lung and/or liver | HR+ 85.5% HER2+ 30.4% TN 7.3% |
| 1. Increase in median survival for surgery upfront 2. Superior survival for locoregional treatment in women with luminal tumors, age < 55 years, and solitary bone metastases |
ECOG-ACRIN E 2108, NCT01242800 | 258 | Bone and/or any organ system, including CNS | HR+/HER2− 60% HER2+ 26% TN 15% |
| 1. No difference in OS and PFS 2. Possible detrimental effect of locoregional treatment in TN mBC 3. Increase of 2.5x risk of locoregional progression in patients who received systemic therapy without locoregional treatment |
TBCRC 013, NCT00941759 | 127 | Bone and/or any organ system, including CNS | HR+/HER2– HR+/HER2+ HR−/HER2+ HR−/HER2− |
| 1. No improvement of PFS and OS for surgery in patients who have responded to first-line treatment |
Trial | Number of Patients | CDK4/6-I | Outcome |
---|---|---|---|
Hans et al. | 5 | Palbociclib | 5 pain relief 1 stable disease |
Meattini et al. | 5 | Ribociclib | 3 stable disease 2 partial response |
Chowdary et al. | 16 | Palbociclib | 16 pain relief 0 local failures |
Ippolito et al. | 16 | Palbociclib Ribociclib | 16 pain relief 2 complete responses 2 partial responses 1 stable disease |
Mudit et al. | 16 | Palbociclib | 16 pain relief 0 local failures |
Guerini et al. | 18 | Palbociclib Ribociclib Abemaciclib | 16 pain relief 0 pain recurrence 17 local control 1 local recurrence |
Trial | Objective | Site of Metastases |
---|---|---|
NCT01646034 | Role of high-dose polychemotherapy in HRD OMBC | 1 to 3 distant metastatic lesions, with or without primary tumor, local recurrence, or locoregional lymph node metastases, including the ipsilateral axillary, parasternal, and periclavicular regions |
CLEAR, NCT03750396 | Local treatment (including surgical resection, stereotactic body radiotherapy, palliative radiotherapy, and radiofrequency ablation) in addition to endocrine treatment as 1st line for HR+/HER2- OMBC | ≤2 lesions in single organ or site (lung, bone, liver, adrenal glands, distant LNs) |
STEREO-SEIN, NCT02089100 | Role of metastases SBRT with curative intent in de novo oligometastatic disease | ≤5 metastatic lesions (measurable or not) No brain metastases |
NCT02364557 | Use of SABR and/or traditional surgery in addition to standard of care systemic therapy in the first-line setting for newly diagnosed OMBC | ≤4 metastases in lung, bone, spine, abdominal-pelvic (lymph node/adrenal gland), liver, mediastinal/cervical lymph node |
BOSTON-II, NCT02303366 | Role of SABR followed by 6 months of anti-PD1 therapy with pembrolizumab, intending to show both safety and enhanced immune activation | 1 to 5 metastases No evidence of visceral metastases in liver or brain |
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Barberi, V.; Pietragalla, A.; Franceschini, G.; Marazzi, F.; Paris, I.; Cognetti, F.; Masetti, R.; Scambia, G.; Fabi, A. Oligometastatic Breast Cancer: How to Manage It? J. Pers. Med. 2021, 11, 532. https://doi.org/10.3390/jpm11060532
Barberi V, Pietragalla A, Franceschini G, Marazzi F, Paris I, Cognetti F, Masetti R, Scambia G, Fabi A. Oligometastatic Breast Cancer: How to Manage It? Journal of Personalized Medicine. 2021; 11(6):532. https://doi.org/10.3390/jpm11060532
Chicago/Turabian StyleBarberi, Vittoria, Antonella Pietragalla, Gianluca Franceschini, Fabio Marazzi, Ida Paris, Francesco Cognetti, Riccardo Masetti, Giovanni Scambia, and Alessandra Fabi. 2021. "Oligometastatic Breast Cancer: How to Manage It?" Journal of Personalized Medicine 11, no. 6: 532. https://doi.org/10.3390/jpm11060532